Registration Form
Commemorative Pathway Bricks
Summer House at Kanapaha Botanical Gardens
Fill out the brick exactly as you wish it to appear
(please print clearly -- one character per space)
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(please print clearly the following information)
YOUR NAME___________________________________________________
ADDRESS_____________________________________________________
CITY, STATE, ZIP____________________________________________
TELEPHONE NUMBER (_________)________________________________
NUMBER OF BRICKS YOU WISH TO REGISTER AT $100 EACH _________
TOTAL AMOUNT OF YOUR CONTRIBUTION (THANK YOU) $_____________
Please mail your check with the above completed form to:
KANAPAHA BOTANICAL GARDENS
4625 SW 63rd Blvd.
Gainesville, Florida 32608
For more information contact:
Dr. Don Goodman, Director of Kanapaha Botanical Gardens
(352) 372-4981